In the current economy, a key objective in hospitals and other institutions providing patient care is to maintain acceptable levels of such care while minimizing the costs. Since intensive care units (ICU's) and the bedside monitors maintained in such units are very expensive, efforts have been made to move patients out of ICU's to step-down units as soon as it is safe for the patient to do so and to utilize far less expensive telemetry monitors to monitor various physiological conditions of the patient rather than expensive bedside monitors.
However, there is a price to be paid for such reduced costs in various applications of such devices. In particular, telemetry monitors are designed to be worn by a patient and to permit the patient to have freedom of movement within at least selected areas of the institution while still being monitored. It is, therefore, desirable that these monitors be made as small and light in weight as possible. Since such monitors are battery-operated, an effort is also made to minimize drains on the battery(s). For these reasons, and also to reduce the costs of the units, telemetry monitors typically contain an appropriate physiological monitor/measuring device, a simple processor device (generally a microprocessor chip) which is hard-wired or programmed to suitably process information received from the monitor and convert it into suitable form for transmission and a radio frequency (RF) or other suitable transmitter for outputting the processed monitor information to a suitable receiver which leads to a central monitoring station, generally also located in the step-down unit. Such patient telemetry monitors do not, however, typically contain any type of display for displaying representations of the monitored outputs, nor do they contain any type of input device. At most, such devices may contain a single "panic" button which a patient may press in the event the patient is experiencing a problem and requires assistance and/or some type of simple display which provides an indication of electrode or battery condition for the monitors.
This lack of input capability and of display can create problems in a number of situations where such telemetry monitors are utilized and make such monitors far less versatile and their use far less desirable than would be the case if such facilities were available. Such situations include:
(a) When the monitors is being placed on the patient, a need exists to assure that the device is being properly mounting the desired signal. For example, where the telemetry monitors contains an ECG monitor, the medical personnel mounting the monitor must assure both that electrodes are properly positioned for the particular patient to provide desired outputs and that the electrodes are making good electrical contact. This can easily be determined by viewing the ECG output obtained from the monitor. However, since with a standard telemetry monitor such information appears only at for example the central nursing station in the hospital step-down monitors, the person mounting the telemetry monitor must position the electrodes and then run to the nursing station or call the nursing station to verify that they have been properly placed. This procedure may require several iterations before the electrodes are properly placed, making the mounting operation take far more time, be far more complicated, involve more people and be much more expensive than it need be. PA1 (b) A second situation where lack of display is a problem is where a patient is experiencing a problem. With current apparatus, when personnel arrive at the scene where a patient is experiencing problems, they must bring a cumbersome and expensive monitoring device with them and hook the monitoring device up to the patient before they can obtain a visual indication of the exact nature of the patient's problem and determine if remedial steps they are taking are alleviating the problem. This can cause precious time to be lost while the equipment is located and transported to the location where the patient is experiencing difficulty and additional time to be lost while the new equipment is being hooked up to the patient. It would be preferable if such information were immediately available from the existing telemetry monitor already hooked up to the patient. PA1 (c) Still another situation where the lack of display for these devices is a problem is where a doctor or nurse is making rounds or, in a teaching hospital, where a doctor is taking students on rounds. With the current situation, physiological information such as a patient's temperature and pulse can be taken in the patient's room, but the doctor or nurse must go to a central nursing station to view the physiological information from the monitor, for example ECG information. PA1 (d) Similar problems arise during drug induction (i.e., for vasoactive drugs there is a requirement to watch the patient's ECG for adverse affects) or routine monitoring and during troubleshooting of the hardware or of a physiological problem of the patient where the person doing such troubleshooting is basically operating blind.
The lack of an input capability is also a problem in that it is not possible to easily change the mode of operation of the monitor, to cause the processor in the telemetry monitor to process information differently before transmission, or to input additional information at the patient's bedside to be transmitted with the monitor output to the central station, either for viewing by personnel at that station or for storage with the patient's records. For example, when a nurse is doing rounds, it would be desirable if the nurse could input physiological readings such as temperature, pulse and the like taken by the nurse and have this information transmitted for storage with the patient's records along with the ECG or other physiological information on the patient being transmitted by the telemetry monitor. Such an input capability would speed the flow of data into the system, since otherwise such information would get into the system only from a downloading of a suitable machine carried by a doctor or nurse at the end of the rounds or from transcription and manual data entry of handwritten notes taken by such medical personnel during rounds, and would therefore improve patient care and reduce the likelihood of errors occurring. For example, particularly if a back channel capability from the central station were also provided, if a reading differed significantly from prior readings, an indication could be provided to the doctor or nurse doing the examination to recheck such reading to assure that it is not an error. A back channel capability would also permit additional information concerning the patient to be provided to the medical personnel doing rounds, or to medical personnel responding to an emergency so as to assure that necessary diagnostic procedures are performed and that the patient receives proper treatment. For example, in an emergency situation, the responding personnel could be alerted to drug allergies which a patient may have or to special care which the patient may require in such emergency situations. During rounds, a knowledge of the patient's specific condition would assure that appropriate readings are taken on the patient so that the particular problems of the patient are properly monitored.
However, while the input-output and display capabilities discussed above are desirable for a telemetry monitor, it is still desirable that such capabilities be achievable without any significant increase in the monitor's cost, size, weight and battery usage. As of this time, a solution which meets these contradictory objectives does not exist.